Colangiocarcinoma y hepatocolangiocarcinoma combinado en pacientes con cirrosis / Cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma in cirrhotic patients

Background: Cholangiocarcinoma (CCA) is a primary hepatic tumor, frequently found in patients with liver cirrhosis and biliary tract diseases. Its varieties include isolated CCA or "combined hepatocellular-cholangiocarcinoma" (cHCC-CCA). The latter is uncommon, with poorly defined diagnostic criteria and natural history. Aim: To characterize patients with cirrhosis with a pathological diagnosis of CCA and cHCC-CCA. Material and Methods: Forty-nine liver biopsies with a pathological diagnosis of CCA were reviewed. The clinical records of patients were reviewed to fetch demographic variables, etiology of cirrhosis and clinical presentation. Results: Eight of the 49 patients had cirrhosis (16% of CCA biopsies reviewed). Their median age was 64 (27-71) years and five were females. Four patients had CCA, three patients cHCC-CCA and one had a bifocal tumor. Patients in the CCA group were more commonly symptomatic. Alpha-fetoprotein and CA 19-9 levels were elevated in one of eight and four of six patients, respectively. Within 12 months from diagnosis, five of eight patients died. Conclusions: In most of these cases, the diagnosis of cHCC-CCA and CCA was made in the liver explant study without previous imaging diagnosis. This reinforces the usefulness of the histological study, in specific cases, prior to liver transplantation and emphasizes the importance of systematic explant exploration in these cases.

Colangiocarcinoma, diagnóstico, tratamiento y evolución clínica. Presentación de un caso con sobrevida 5 años / Cholangiocarcinoma: diagnosis, treatment and clinical evolution. Presentation of a case with five-year survival

RESUMEN El colangiocarcinoma es un tumor maligno originado en el epitelio de los conductos biliares intra o extrahepáticos. En el cuadro clínico destacan el dolor en hipocondrio derecho, ictericia y baja de peso. Actualmente, el diagnóstico se ha facilitado por la disponibilidad de variados procedimientos imagenológicos y endoscópicos. Se presentó un caso al que se le realizó el diagnóstico de este tipo de tumor. Se sometió a tratamiento endoscópico, quirúrgico y oncológico con Gemcitabina, Cisplatino y Oxaliplatino. Fue seguido por equipo multidisciplinario y evolucionó con sobrevida de 5 años (AU).

ABSTRACT Cholangiocarcinoma is a malignant tumor originated in the epithelium of the intra or extra hepatic biliary ducts. Pain in the right hypochondrium, jaundice and low weight are the main clinical features. Currently, the diagnosis has been facilitated by the availability of different imaging and endoscopic procedures. The authors presented a case diagnosed with this kind of tumor. The patient underwent surgical, endoscopic and oncologic treatment with gemcitabine, cisplatine and oxaliplatine. He was followed up by a multidisciplinary team and evolved with five-year survival (AU).

Colangiocarcinoma intrahepatico con manifestaciones clínicas atípicas: reporte de caso / Intrahepatic cholangiocarcinoma with atípical clinical manifestations, case report

El colangiocarcinoma es una neoplasia de la vía biliar, siendo el segundo cáncer hepático primario más frecuente en el mundo, con una incidencia del 2%. Predomina enhombres, la sobrevida en estados tempranos es de 40 meses con cirugíay 12 meses con quimioterapiaen estados mas avanzados.Objetivo:identificar manifestaciones clínicas no específicas, que orienten al médico a realizar un diagnóstico temprano del Colangiocarcinoma. Presentación del caso clínico: paciente masculino, en la sexta década de la vida, diabético, con historia de 18 meses de presentar fatiga y tos seca sin predominio de horario, durante el proceso diagnóstico se encontró hepatomegalia y anemia microcítica hipocrómica.La tomografía computarizada abdominal, reveló masa heterogénea en hígado. El resultado de los marcadores tumorales CA 19.9 y antígeno carcinoembrionario fueron normales.Conclusión: el colangiocarcinoma es un tipo de cáncer que se puede presentar con síntomas inespecíficos por lo que la sospecha clínica puede ser difícil y debe apoyarse en estudios complementarios...(AU)

Fasciolosis intrahepática que simulaba un colangiocarcinoma: Reporte de un caso infrecuente / Intrahepatic fasciolosis that simulated a cholangiocarcinoma: Report an infrequent case

La fasciolosis es una infección parasitaria causada por 2 tipos de fasciola, siendo la más común de tipo hepática, la forma infectante son las metacercarias. Su prevalencia radica en zonas de nivel socioeconómicas bajo y zonas ganaderas. El objetivo es presentar un caso de presentación atípica en el que se evitó someter al paciente a un tratamiento quirúrgico innecesario. Presentamos un caso de un paciente masculino de 69 años que presentó Colangitis, su ecografía y tomografía evidenció dilatación de la vía biliar, por lo que se le realizó una con la colangiopancreatografía retrograda endoscópica (CPRE) evidenciándose una estenosis de colédoco cerca de la bifurcación biliar y una larva de fasciola hepática, la endomicroscopía confocal (EM) no era concluyente, se tomó biopsia de la estenosis que reportó colangiocarcinoma, pero como el paciente no tenía pérdida patológica de peso y marcadores tumorales negativos, se le indicó tratamiento antiparasitario y se realizó una nueva CPRE que evidenció en la EM mucosa inflamatoria de aspecto crónico no tumoral que se confirmó con la nueva biopsia, el paciente tuvo una evolución favorable, de esta forma evitamos un tratamiento no requerido.

Fasciolosis is a parasitic infection caused by 2 types of fasciola, being the most common of hepatic type, the infective form is the metacercariae. Its prevalence lies in low socio-economic zones and livestock areas. The objective is to present a case of atypical presentation in which the patient was avoided to undergo an unnecessary surgical treatment. We present a case of a 69-year-old male patient who presented Cholangitis, his sonography and tomography evidenced dilatation of the bile duct, and one was performed with endoscopic retrograde cholangiopancreatography (ERCP), showing a choledochal stenosis near the bile bifurcation And a liver fasciola larva, confocal endomicroscopy (MS) was inconclusive, biopsy of the stenosis that reported cholangiocarcinoma was reported, but since the patient had no pathological weight loss and negative tumor markers, he was given antiparasitic treatment and was performed A new ERCP that showed in the inflammatory mucosa of chronic non-tumor aspect that was confirmed with the new biopsy, the patient had a favorable evolution, thus avoiding an unnecessary treatment.

Colangiocarcinoma em cão com metástase em omento, linfonodos regionais e pâncreas ­ Relato de caso / Cholangiocarcinoma in dog with metastatic omentum, regional lymph nodes and pancreas - Case report / Colangiocarcinoma en perro con metástasis en epiplón, ganglios linfáticos regionales y páncreas ­ Relato de caso

Os colangiocarcinomas são neoplasmas malignos originados de ductos biliares ou da vesícula biliar que apresentam como principal diagnóstico diferencial os hepatocarcinomas com padrão acinar. Relata-se aqui um caso de colangiocarcinoma de ductos biliares em um cão com metástase em omento, linfonodos regionais e pâncreas, diagnosticado no Laboratório de Patologia Veterinária da UFPR ­ Setor Palotina.

Cholangiocarcinomas are malign neoplasms originated from bile ducts or from the gallbladder that present hepatocellular carcinomas with acinar pattern as the main differential diagnostic. This work has the objective of describing a case of cholangiocarcinoma of the bile ducts in a dog with metastasis in omentum, regional lymph nodes and pancreas, diagnosed at the Veterinary Pathology Laboratory of UFPR ­ Setor Palotina.

Los colangiocarcinomas son neoplasmas malignos originados de vías biliares o de la vesícula biliar que presentan como principal diagnóstico diferencial los hepatocarcinomas con estándar acinar. Se describe un caso de colangiocarcinoma de vías biliares en un perro con metástasis en el epiplón, nódulos linfáticos regionales y páncreas, diagnosticado en el Laboratorio de Patología Veterinaria de la UFPR ­ Sector de Palotina.

El rol de la endoscopia avanzada en enfermedades inflamatorias intestinales: terapéutica y vigilancia de neoplasias / The role of advanced endoscopy in inflammatory bowel diseases: therapeutic and neoplasms surveillance

Las enfermedades inflamatorias intestinales representan una patología de alta morbilidad. Esto debido a que se asocia a mayor su riesgo de desarrollo de neoplasias tanto colorrectales como colangiocarcinoma, desarrollo de complicaciones como fístulas, abscesos, estenosis intestinales espontáneas o postoperatorias y estenosis biliares en aquellas asociadas a colangitis esclerosante primaria. El rol del endoscopista avanzado en este grupo de pacientes se encuentra en la vigilancia de ambas neoplasias y en el tratamiento endoscópico de las complicaciones ya mencionadas. En relación a la vigilancia de cáncer colorrectal, existen distintas recomendaciones internacionales respecto a los intervalos y las técnicas de vigilancia, situándose la cromoendoscopia como método de elección emergente en los últimos años. Es importante destacar la publicación del uso de nueva nomenclatura para los hallazgos colonoscópicos durante la vigilancia del cáncer colorectal, abandonando los conceptos de DALM o lesiones o masas asociadas a displasia, lesiones tipo adenoma o no adenomatosas.

Inflammatory bowel diseases represent a high morbidity pathology given their high risk of developing both colorectal cancer and cholangiocarcinoma, besides the development of fistulas, abscesses, spontaneous or postoperative intestinal stenosis and biliary strictures in patients diagnosed with primary sclerosant cholangitis. The advanced endoscopist's rol in this group of patients lies within surveillance of both neoplasms and the endoscopic treatment of complications already mentioned. In relation to surveillance of colorectal cancer, there are various international recommendations regarding surveillance intervals and techniques, with chromoendoscopy emerging as a method of choice in recent years. It is important to highlight the use of new nomenclature for colonoscopic findings during surveillance, abandoning concepts as DALM, adenoma-like lesions or non adenoma-like lesions.

Hep Par-1: a novel immunohistochemical marker for differentiating hepatocellular carcinoma from metastatic carcinoma

To evaluate the diagnostic utility of Hep par-1 in differentiating hepatocellular carcinoma from metastatic carcinoma taking histopathology as a gold standard. Comparative cross-sectional study. Pathology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from April 2007 to February 2008. Hep par-1 immunohistochemical stain was performed on 60 cases of liver carcinoma, 30 cases each of metastatic and hepatocellular carcinoma. Information regarding patient age, gender, sign and symptoms, radiographic findings, histological grade of tumour, and expression of Hep par-1 on hepatocellular and metastatic carcinoma were recorded on proforma sheet. Sensitivity, specificity, positive and negative predictive values, and accuracy of Hep par-1 were calculated using the formulas. Hep par-1 expression was noted in 25 out of 30 cases of hepatocellular carcinoma [83%]. Out of 30 cases of metastatic carcinoma, only one case expressed staining in < 5% tumour cells and remaining 29 cases showed no reactivity. The age of the patients with hepatocellular carcinoma ranged from 40 to 76 years with a median age of 60.5 years and 40 - 75 years for metastatic carcinomas with a median age of 57.5 years. Hep par-1 is a reliable immunohistochemical marker for cases of hepatocellular carcinoma [HCC]. It can be used along with other markers in morphologically difficult cases when differential diagnosis lies between poorly differentiated HCC and metastatic carcinoma of liver

Clinical Usefulness of Bile Cytology Obtained from Biliary Drainage Tube for Diagnosing Cholangiocarcinoma / 대한소화기학회지

BACKGROUND/AIMS: Biliary drainage is performed in many patients with cholangiocarcinoma (CCA) to relieve obstructive jaundice. For those who have undergone biliary drainage, bile cytology can be easily performed since the access is already achieved. This study aims to determine the clinical usefulness of bile cytology for the diagnosis of CCA and to evaluate factors affecting its diagnostic yield. METHODS: A total of 766 consecutive patients with CCA underwent bile cytology via endoscopic nasobiliary drainage or percutaneous transhepatic biliary drainage from January 2000 to June 2012. Data were collected by retrospectively reviewing the medical records. We evaluated the diagnostic yield of bile cytology with/without other sampling methods including brush cytology and endobiliary forcep biopsy, and the optimal number of repeated bile sampling. Several factors affecting diagnostic yield were then analyzed. RESULTS: The sensitivity of bile cytology, endobiliary forceps biopsy, and a combination of both sampling methods were 24.7% (189/766), 74.4% (259/348), and 77.9% (271/348), respectively. The cumulative positive rate of bile sampling increased from 40.7% (77/189) at first sampling to 93.1% (176/189) at third sampling. On multivariate analysis, factors associated with positive bile cytology were perihilar tumor location, intraductal growing tumor type, tumor extent > or =20 mm, poorly differentiated grade tumor, and three or more samplings. CONCLUSIONS: Although bile cytology itself has a low sensitivity in diagnosing CCA, it has an additive role when combined with endobiliary forceps biopsy. Due to the relative ease and low cost, bile cytology can be considered a reasonable complementary diagnostic tool for diagnosing CCA.

A Case of Fasciola hepatica Infection Mimicking Cholangiocarcinoma and ITS-1 Sequencing of the Worm

Fascioliasis is a zoonotic infection caused by Fasciola hepatica or Fasciola gigantica. We report an 87-year-old Korean male patient with postprandial abdominal pain and discomfort due to F. hepatica infection who was diagnosed and managed by endoscopic retrograde cholangiopancreatography (ERCP) with extraction of 2 worms. At his first visit to the hospital, a gallbladder stone was suspected. CT and magnetic retrograde cholangiopancreatography (MRCP) showed an intraductal mass in the common bile duct (CBD) without proximal duct dilatation. Based on radiological findings, the presumed diagnosis was intraductal cholangiocarcinoma. However, in ERCP which was performed for biliary decompression and tissue diagnosis, movable materials were detected in the CBD. Using a basket, 2 living leaf-like parasites were removed. The worms were morphologically compatible with F. hepatica. To rule out the possibility of the worms to be another morphologically close species, in particular F. gigantica, 1 specimen was processed for genetic analysis of its ITS-1 region. The results showed that the present worms were genetically identical (100%) with F. hepatica but different from F. gigantica.

Right portal vein embolization by laparoscopic catheterization of the inferior mesenteric vein / Embolizacao percutanea da veia porta por acesso laparoscopico da veia mesenterica inferior

Right portal vein embolization is often performed to prevent liver insufficiency after major hepatic resection. The procedure usually involves direct puncture of the portal vein, which requires hepatic hilum manipulation, and may be associated with liver injury, pneumothorax, and hemoperitoneum. This report describes a technique of laparoscopic insertion of a sheath into the inferior mesenteric vein followed by right portal vein embolization.

Habitualmente, a embolização do ramo direito da veia porta é realizada para prevenir insuficiência hepática após uma ressecção hepática estendida. Geralmente, este procedimento é realizado por punção direta da veia porta, resultando, ocasionalmente, em lesão hepática, pneumotórax e hemoperitônio. No presente relato, descrevemos uma alternativa ao acesso direto à porta, através da cateterização percutânea da veia mesentérica inferior com o auxílio da dissecção videolaparoscópica.

Rendimiento diagnóstico del marcador tumoral CA 19-9 en la diferenciación entre patología bilio-pancreática benigna y maligna / Accuracy of the tumor marker CA 19-9 in the differentiation of benign and malignant bilio-pancreatic diseases

Introduction: CA 19-9 has been identified as a derivative of sialic Lewis blood group A and is expressed in 95 percent of the population. Several studies have documented an overproduction of CA 19-9 in malignant pancreatic and biliary tree diseases. The objective of this study is to determine the accuracy of the tumor marker CA 19-9 differentiating benign and malignant bilio-pancreatic diseases. Material and Methods: diagnostic test study. We reviewed the records of all patients with malignant bilio-pancreatic diseases and benign biliary calculous diseases evaluated in Hospital Base Osorno between august 2007 and december 2011, with CA 19-9 as part of their study. Results: 71 patients met the inclusion criteria, 17 men and 54 women, with a mean age of 60.7 +/- 15.3 years old. Twenty nine (40.8 percent) cases were benign and 42 (59.2 percent) cases malignant. For a cutoff level of 37 U/ml the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) to differentiate benign from malignant disease was 81 percent, 72.4 percent, 81 percent and 72.4 percent, respectively. For a cut off level of 130 U/ml specificity and PPV increased to 96.6 percent and 96.4 percent, respectively. Conclusions: the use of CA 19-9 is useful in the diagnosis of patients with suspected bilio-pancreatic malignant disease. The optimization of the normal published value can help to improve accuracy.

Introducción: El CA 19-9 se ha identificado como un derivado siálico del grupo sanguíneo Lewis A y se expresa en el 95 por ciento de la población. Numerosos estudios han documentado una sobreproducción de CA 19-9 en tumores malignos del árbol biliar y páncreas. El objetivo de este estudio es determinar la utilidad del marcador tumoral CA 19-9 en la diferenciación de patología bilio-pancreática benigna y maligna. Material y Métodos: estudio de pruebas diagnósticas. Se revisaron los antecedentes de todos los pacientes con patología bilio-pancreática maligna y enfermedad litiásica biliar benigna, evaluados en el Hospital Base de Osorno entre agosto de 2007 y diciembre de 2011, a los que se les haya solicitado CA 19-9 como parte de su estudio. Resultados: 71 pacientes cumplieron los criterios de inclusión, 17 hombres y 54 mujeres, con una media de 60,7 +/- 15,3 años de edad. Veintinueve (40,8 por ciento) casos correspondieron patología benigna y 42 (59,2 por ciento) casos a patología maligna. Para un valor de corte de 37 U/ml la sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN) para diferenciar enfermedad benigna de maligna fue de 81 por ciento, 72,4 por ciento, 81 por ciento y 72,4 por ciento, respectivamente. Para un valor de corte de 130 U/ ml la especificidad y el VPP aumentaron a 96,6 por ciento y 96,4 por ciento, respectivamente. Conclusiones: el uso del Ca 19-9 es útil en el proceso diagnóstico de pacientes con sospecha de patología bilio-pancreática maligna. La optimización de los valores sobre el valor de normalidad publicado puede ayudar a mejorar su rendimiento.

Colangioscopia peroral mono operador (Spyglass): experiencia preliminar en el Hospital Vargas de Caracas, Caracas, Venezuela / Single operator peroral cholangioscopy (Spyglass): preliminary experience at the \"Hospital Vargas de Caracas\", Caracas, Venezuela

Spyglass es un sistema monooperador recientemente desarrollado para realización de colangioscopia permitiendo la evaluación de los ductos biliares. Demostrar la experiencia preliminar en Venezuela en un hospital público con colangioscopia peroral monooperador (Spyglass) en pacientes con patología biliar. Estudio prospectivo (febrero - abril 2012), Hospital Vargas de Caracas. Se incluyeron 9 pacientes (6 hombres, 3 mujeres), edad media 50,44 años (28 - 83 años) con patología bilio-pancreática. Indicaciones: litiasis biliar (3), estenosis (1), colangitis (1), tumores.5 De los 9 pacientes, 5 fueron sometidos a esfinterotomía y 4 estaban previamente instrumentados. En 4 pacientes se realizó dilatación de la esfinterotomía. En 7 pacientes (6 con estenosis y 1 con litiasis biliar gigante) se colocó stent (7 plásticos y 1 metálico autoexpandible) post spyglass. Sedación fue monitoreada por anestesiología y administración antibiótico profiláctico. Spyglass fue realizado en 9 pacientes (1 paciente fue fallida por problemas técnicos del haz de luz). Spyglass pudo ser insertado en el colédoco en 9 pacientes (100%), ductos intrahepáticos 3 (33,3%) y adecuada visualización en 8 pacientes (88,9%). Hallazgos: lesiones exofíticas neovascularizadas 4 (44,4%), litiasis 1 (11,1%), estenosis 2 (22,2%), normal 2 (22,2%). En 2 pacientes (1 con estenosis, otro lesión exofítica) se tomó biopsias (inflamatorio y colangiocarcinoma respectivamente). No hubo complicaciones. Spyglass es un endoscopio miniatura mono operador efectivo en la evaluación y tratamiento de cálculos y lesiones biliares

Spyglass is a mono operated system recently developed for the practice of cholangioscopy that permits the direct evaluation of the biliary ducts. To demonstrate the preliminary experience in Venezuela in a public hospital with mono operated peroral cholangioscopy (Spyglass) in patients with biliary disease. Patients and Methods: Prospective study (february - april 2012), 9 patients (6 men, 3 women) mean age 50,44 years old (28-83) with biliopancreatic disease. Indications: lithiasis (3), stenosis (1), cholangitis (1) and tumors (5). Of the 9 patients, in 5 sphinterotomy was performed and 4 were previously instrumented. In 4 patients dilatation of the sphinterotomy was performed. In 7 patients (6 with stenosis, 1 with a giant biliary stone) a stent was placed (7 plastic and 1 autoexpandible) after Spyglass. Sedation monitored by anesthesiologist and prophylactic antibiotic. Spyglass was performed in 9 patients (1 patient was unsuccessful due to technical problems). Spyglass could be inserted into the common bile duct in 9 patients (100%), intrahepatic ducts 3 (33.3%) and adequate visualization was acquired in 8 patients (88.9%). Findings: exophytic lesions neovascularizadas 4 (44.4%), lithiasis 1 (11.1%), stenosis 2 (22.2%), normal 2 (22.2%). In 2 patients (1 with stenosis, another with exophytic lesion) took biopsies (inflammatory and cholangiocarcinoma, respectively). There were no complications. Spyglass is a miniature endoscope mono operated effective in the evaluation and treatment of lithiasis and biliary lesions. There were no complications

Primary Tumor Maximum Standardized Uptake Value Measured on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Is a Prognostic Value for Survival in Bile Duct and Gallbladder Cancer / 대한소화기학회지

BACKGROUND/AIMS: Few studies have assessed the prognostic value of the primary tumor maximum standardized uptake value (SUVmax) measured by 2-[18F]-fluoro-2-deoxy-D-glucose PET-CT for patients with bile duct and gallbladder cancer. METHODS: A retrospective analysis of 61 patients with confirmed bile duct and gallbladder cancer who underwent FDG PET-CT in Kangbuk Samsung Medical Center (Seoul, Korea) from April 2008 to April 2011. Prognostic significance of SUVmax and other clinicopathological variables was assessed. RESULTS: Twenty-three patients were diagnosed as common bile duct cancer, 17 as hilar bile duct cancer, 12 as intrahepatic bile duct cancer, and nine as gallbladder cancer. In univariate analysis, diagnosis of intrahepatic cholangiocarcinoma and gallbladder cancer, mass forming type, poorly differentiated cell type, nonsurgical treatment, advanced American Joint Committee on Cancer (AJCC) staging and primary tumor SUVmax were significant predictors of poor overall survival. In multivariate analysis adjusted for age and sex, primary tumor SUVmax (hazard ratio [HR], 4.526; 95% CI, 1.813-11.299), advanced AJCC staging (HR, 4.843; 95% CI, 1.760-13.328), and nonsurgical treatment (HR, 6.029; 95% CI, 1.989-18.271) were independently associated with poor overall survival. CONCLUSIONS: Primary tumor SUVmax measured by FDG PET-CT is an independent and significant prognostic factor for overall survival in bile duct and gallbladder cancer.

Synchronous Double Primary Hepatic Cancer: Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma / 대한소화기학회지

No abstract available.

A Case of Intrahepatic Cholangiocarcinoma Associated with Type IV Choledochal Cyst / 대한소화기학회지

Anomalous union of the pancreaticobiliary duct (AUPBD) is a congenital anomaly that is defined as a junction of the bile duct and pancreatic duct outside the duodenal wall. This anomaly results in a loss of normal sphincteric mechanisms at the pancreaticobiliary junction. As a result, regurgitation of pancreatic juice into the biliary system develops and causes choledochal cysts, choledocholithiasis, cholangitis, pancreatitis and malignancy of the biliary tract. Gallbladder cancer or common bile duct cancer associated with AUPBD and choledochal cysts have been frequently reported. But, intrahepatic cholangiocarcinoma associated with this condition has been only rarely reported. Here, we report a case of intrahepatic cholangiocarcinoma associated with AUPBD and choledochal cyst.

Colangiocarcinoma en el 2011 / Cholangiocarcinoma in 2011

Cholangiocarcinoma is a rare disease in the western World, but it comprises a diagnostic and therapeutic challenge. Its outcome strongly depends on early diagnosis and complete surgical resection. As of today there are no surgical procedures that have proved increase in the survival rate for patients with these types of tumors. Recently, liver transplant appears as a promising alternative reporting a survival rate over 80 percent in 5 years. However, it has been impossible to replicate these results in the majority of the Centers specialized in the management of this disease. The present article shows epidemiological data of the disease, diagnostic methods and options of treatment according to the staging.

El colangiocarcinoma es una patología infrecuente en el mundo occidental, pero representa un desafío diagnóstico y terapéutico. Su pronóstico es muy dependiente de la precocidad del diagnóstico y la resección quirúrgica completa. Hasta ahora no existen terapias no quirúrgicas que hayan demostrado aumentar la sobrevida para este tipo de tumores. Últimamente, el trasplante de hígado aparece como una alternativa promisoria con reportes de sobrevida por sobre el 80 por ciento a 5 años, sin embargo, estos resultados no han podido ser replicados por la mayoría de los centros con alta experiencia en el manejo de esta enfermedad. En el presente artículo se detallan los antecedentes epidemiológicos de la enfermedad, los métodos diagnósticos y opciones de tratamiento según el estadío.

Liver Flukes: the Malady Neglected

Liver fluke disease is a chronic parasitic inflammatory disease of the bile ducts. Infection occurs through ingestion of fluke-infested, fresh-water raw fish. The most well-known species that cause human infection are Clonorchis sinensis, Opisthorchis viverrini and Opisthorchis felineus. Adult flukes settle in the small intrahepatic bile ducts and then they live there for 20-30 years. The long-lived flukes cause long-lasting chronic inflammation of the bile ducts and this produces epithelial hyperplasia, periductal fibrosis and bile duct dilatation. The vast majority of patients are asymptomatic, but the patients with heavy infection suffer from lassitude and nonspecific abdominal complaints. The complications are stone formation, recurrent pyogenic cholangitis and cholangiocarcinoma. Approximately 35 million people are infected with liver flukes throughout the world and the exceptionally high incidence of cholangiocarcinoma in some endemic areas is closely related with a high prevalence of liver fluke infection. Considering the impact of this food-borne malady on public health and the severe possible clinical consequences, liver fluke infection should not be forgotten or neglected.